Community Health Funds: Extension of the National Health
Insurance Fund of Tanzania
Summary
The National Health Insurance Fund (NHIF) was established in 2001, with the basic
objective of providing health insurance to civil servants. Since then, the NHIF has increased
coverage by extending its membership to private, informal and semi-formal sectors. In 2009,
the NHIF was mandated by the Government to manage the Community Health Funds (CHF)
which were initially managed by the local authorities. The main objective of being given this
task was to bring about the growth of the CHF scheme in terms of coverage, number of
members and quality of health services accessible to its beneficiaries.
In fulfilling this task, the NHIF used several innovative approaches and strategies, including
the preparation of the three year implementation plan, training its employees, and conducting
several sensitization and motivation campaigns. Also the NHIF has taken several steps to
conduct monitoring and evaluation on matters pertaining to the scheme.
Through the management of the CHF, the NHIF has learnt several practical lessons about the
CHF and social insurance schemes in general. The application of these lessons can be
extended to similar schemes in the sub-Saharan region.
CRITERIA 1:
What was the issue/problem/challenge addressed by your good
practice? Please provide a short description.
There was a need to introduce a health system that would allow cost sharing on health
services. This system was supposed to involve a large part of the population, including
individuals who were in the informal sector of the economy, and was also supposed to be
guided by a legal framework.
To cater for this need, the Government launched the CHF in 2001 with the primary objective
of establishing a system which would eventually allow all citizens to be covered by a health
insurance scheme. Following the success of the NHIF, the Ministry of Health handed the task
of supervising the CHF to the NHIF so that it could include the means to integrate CHF
beneficiaries with its own beneficiaries in its long term plans. Hence, over time, the NHIF
will cover the majority of Tanzania’s population.
CRITERIA 2:
What were the main objectives and the expected outcomes?
Objective
The main objective of handing the NHIF the task of supervising and managing the CHF was
to bring about the growth of the CHF in terms of coverage, and quality and quantity of health
2
services that would be accessible to its beneficiaries. This was based mainly on the experience
and success that the NHIF had in its own operations.
Expected outcomes
The NHIF’s supervision and management of the CHF was expected to bring about the
following outcomes:
• Bring about cost sharing in health services provision in the country by ensuring that
most citizens – through their CHF contributions – supplement the amount of funds the
Government sets aside for the health sector.
• Improve medical services in order to have a high standard of health care. This would
involve increasing the availability of health personnel, medicines, medical equipment,
and other facilities.
• Give autonomy to the community on issues pertaining to health care, so that they
would be involved in making plans, decisions, and supervision on health matters.
CRITERIA 3:
What is the innovative approach/strategy followed to achieve the
objectives?
After being mandated to manage the CHF, the NHIF undertook research on the CHF, using
various secondary sources, in order to know more about the scheme. Then the NHIF
undertook various tasks related to the CHF, as follows:
• evaluated the net worth of the CHF in the whole country, in September, 2010;
• built capacity in its employees, through providing internal training from August 2009
to June 2010 for its management and other workers;
• prepared a three-year Implementation Plan for the CHF to run from July 2009 to July
2012;
• urged several councils to start CHFs;
• trained various editors and journalists, all over the country to promote the CHF;
• made payments of “Matching Funds” from March 2010;
• reviewed in May 2010 the “Matching Funds Payment” exercise and various contracts
pertaining to the CHF;
• undertook group enrolments in Tanga and Lindi regions.
3
CRITERIA 4:
Have the resources and inputs been used in an optimal way to
achieve the set objectives and the expected outcomes? Please
specify what internal or external evaluations of the practice have
taken place and what impact/results have been identified/achieved
so far.
Optimal way to achieve the set objectives
Since 2009, when the NHIF took on the task of managing the CHF, it has monitored the
scheme, mainly through the direct supervision of district councils. Two supervisions have
been undertaken so far, one in October 2010 and the other in December 2010.
In October 2010, the NHIF supervised the Kigoma district councils. The aim was to enable
these councils to better understand the requirements for requesting Matching Funds. This was
because most of these councils had not been given all the Matching Funds they requested
from the Government. This occurred for several reasons, such as they had excluded important
documentation from their request to the Government soliciting Matching Funds.
In December, 2010, another supportive supervision was done in Mpwapwa, Iramba, and
Singida Rural councils. This supervision had several objectives:
• verify the presence of Matching Funds records;
• monitor the general system of the councils’ record-keeping;
• assess the practicability of the Matching Funds protocol;
• obtain an overview of how CHF activities are carried out;
• provide technical support in several fields.
Results of the practice
By managing the CHF, the NHIF has increased its coverage in terms of the number of
beneficiaries to 15.2 per cent of all Tanzanians as per the National Population Census of 2002,
with 7.9 per cent being covered by the CHF and the remaining 7.3 per cent being covered
directly by the NHIF.
CRITERIA 5:
What lessons have been learned? To what extent would your good
practice be appropriate for replication by other social security
institutions? Please explain briefly.
Through managing the CHF, the NHIF has gained several lessons pertaining to health service
provision, needs, and ideal management and supervision. These have implications for other
entities similar to the NHIF. Some of these lessons are as follows:
• Many people are ready to contribute and join insurance schemes and other
programmes once they are assured of receiving an adequate level of services. For
instance, in the CHF case, a greater assurance of the availability of adequate health
4
services, mainly due to timely payment of Matching Funds, led to an increase in the
number of members.
• The level of coverage of social schemes is highly influenced by the level of campaigns
and awareness programmes. For instance, since 2009 when the NHIF took over the
supervision of the CHF, the number of households covered has increased from about
two hundred thousand to five hundred thousand, mainly due to the high level of
awareness campaigns.
No comments:
Post a Comment